Before exam

Question 1

which way does the leg rotate when it is dislocated vs when it is fractured

Answer 1

Dislocated
- internally rotated
Fractures
- externally rotated and shortened

Question 2

what is the difference between genu valgus v varum

Answer 2

Valgum - inwards

Varum - outwards

Question 3

whats the difference between herbdens and bouchards nodes

Answer 3

Herbedens - DIP

Bounchards - PIP

Question 4

name the layers of the skin

Answer 4

Stratum corenum 
stratum lucideum 
Stratum granulosum 
stratum spinosum 
stratum basale

Question 5

what technique is used for

• CHD
• club foot
• SUFE
• Osgood- Shalters
• toe walking

Answer 5

• CHD = pavlik harness
• want to wait two to 8 weeks to see if it will resolve
• Closed reduction and immobilization in Pavlik harness
• keep the Hip flexed and abducted while still allowing movement
• In harness for at least 6 weeks full-time and 6 weeks part-time 80-95% success
• can use the ultrasound to see if the hip is relocating
• If hip not reduced in 3 weeks then alternative needed
• can cause avascular necrosis and femoral nerve palsies
• club foot = Ponsetti treatment = Ponseti method – manipulative technique to correct clubfoot without invasive surgery - repetitive plasting over weeks, so you can reshape into a normal condition - after this fixed plaster class requires abduction of the foot brace thus keeping the position of the ankle and foot in the normal positive - in this full time for 24 hours a day for 12 weeks and then every night up to the age of 4
• SUFE
  Rest
  Analgesia
  Surgery
• Closure of epiphyseal growth plate (screws)
• Followed by corrective osteotomy if required
• Osgood- Shalters
• rest
• toe walking - Castingthe foot and ankle for about 6 weeks to help stretch calf muscles, Physiotherapy, Surgery to release tight calf muscles

Perthes disease
If child young (under 5) or in mild cases
- Observation
- physiotherapy
- Bed rest
- Plaster casts or braces
- Abduction to keep femoral head in acetabulum
For older children
- Surgery = Osteotomy - length the femoral head to reduce leg length discrepancy

Blounts 
Conservative
- Brace
Surgical
- Early onset
- When brace fails
- Osteotomy 
- Gradual distraction

Question 6

Describe what happens in pagets disease

Answer 6

phase 1

• initial increase rate of bone reabsorption and there is a large number of giant osteoclasts
• they remove a lot of bone this leads to osteoblast becoming more active

phase 2

• compensatory phase/proliferative
• increase bone formation
• acclearated deposition in disorganised manner
• lots of woven bone being laid down

phase 3

• burnout phase/sclerotic
• bone hypercellularity may diminish leaving paretic bone
• hypervascular bone marrow

Question 7

name the differnet types of hypersnesitivty reaction

Answer 7

type 1 - mast cell
type 2 - cytotoxic
type 3 - immune complex
type 4 - deylated

Question 8

name the rotator cuff muscles and what they do

Answer 8

• supraspinatus -Abducts the arm 0-15o, and assists deltoid for 15-90o
• infraspinatus - Laterally rotates the arm
• subscapularis - Medially rotates the arm
• Teres minor - Laterally rotates the arm

Question 9

what is bamboo spine present in

Answer 9

ankylosing spondylitis

Question 10

How do you diagnose congenital hip dysplasia

Answer 10

Barlow test - adduct and dislocate

Ortolani test - abduct and relocate

Galeazzi sign - push both knees downwards to check to see if they shortern

Question 11

describe how you would diagnose CHD on a radiography

Answer 11

Hilgenreiner’s line (plus acetabular index line) - goes through the epiphyseal growth plate in the pelvis on both sides

acetabular index line - superior lateral across the ilium part of the acetabulum and it intersects and you measure the angle

Perkins line

• better visualised cue
• goes from the Superior lateral aspect of the acetabulum and vertical line straight Dom from there
• looking for where the femoral head is in relation to that line
• in a normal hip it should be medial to that line
• in CHD it is lateral to that line

Question 12

Stages of perthes disease

Answer 12

phase 1 = Necrosis
phase 2 = fragementation
phase 3 = reossification
phase 4 = remodelling

Question 13

What does pagets disease look like

Answer 13

Irregular thickened trabeculae

Prominent cement lines

Bone marrow replaced by fibrovascular connective tissue

trabecular is filled in so looks like cement

Question 14

what’s the difference between omphalocele and gastroschisis and exophalmos

Answer 14

Omphalocele / exomphalos (pronounced uhm-fa-lo-seal) is a birth defect of the abdominal (belly) wall. The infant’s intestines, liver, or other organs stick outside of the belly through the belly button. - covered by a thin sac

In gastroschisis, the opening is near the bellybutton (usually to the right) but not directly over it, like in omphalocele. Like in omphalocele, the opening allows the intestines to spill out but unlike omphalocele, the intestines are not covered by a thin sac.

Question 15

what do V, VII, VIII do

Answer 15

• the extrinsic pathway produces a small amount of thrombin by forming a small amount of Xa
• The initially formed thrombin converts three other factors – V VIII, XI into their active forms Va VIIIa Xia
• Xia then converts factor IX to IXa
• VIIIA and Isa increases conversion of X to Xa
• Va increases effective of the increased Xa

Question 16

what muscle causes a change in the tone of voice

Answer 16

- cricothyroid 
Cricothyroid muscle:
Tilts the thyroid cartilage forwards
Tenses the vocal cords
Raises the pitch

• thryoarytenoid
  Thyroarytenoid muscle and vocalis:
  Pulls the thyroid and arytenoid cartilages together
  Relaxes the vocal cords
  Lowers the pitch
  (Vocalis alters the mass and timbre of the cords)

Question 17

what is the above and below pectinae lines for

• lympathetics
• artery
• venous drainage

Answer 17

Above

• lympathetics - internal iliac
• artery - inferior mesenteric artery
• venous drainage - inferior mesenteric vein

Below

• lympathetics - superficial inguinal lymph nodes
• artery - internal pudendal artery
• venous drainage - intenral pudendal vein

Question 18

what causes

• turner syndrome
• klinefelters
• 46 XY

Answer 18

• turner syndrome - Missing an X chromosome
• klinefelters - 47XXY
• 46 XY - disorder of sex development (DSD) is a condition in which an individual with one X chromosome and one Y chromosome in each cell, the pattern normally found in males, have genitalia that is not clearly male or female. Infants with this condition tend to have penoscrotal hypospadias, abnormal development of the testes, and reduced to no sperm production. - swyer syndrome

Question 19

what causes

• turner syndrome
• klinefelters
• 46 XY

Answer 19

• turner syndrome - Missing an X chromosome
• klinefelters - 47XXY
• 46 XY - disorder of sex development (DSD) is a condition in which an individual with one X chromosome and one Y chromosome in each cell, the pattern normally found in males, have genitalia that is not clearly male or female. Infants with this condition tend to have penoscrotal hypospadias, abnormal development of the testes, and reduced to no sperm production. - swyer syndrome

Question 20

what causes horizontal coding and vertical coding

Answer 20

In the utricles, hair cells are polarized (excited) towards the striola. Provides horizontal encoding.

Striola - - narrow central area of the utricular macula where the orientations of the tallest stereocilia and kinocilia change).
- Provides vertical encoding.

Question 21

how many genes make up an exome

Answer 21

The exome of the human genome consists of roughly 180,000 exons constituting about 1% of the total genome,

Question 22

46xy - poor pubertal hair grotwth, breasts, no pubic hair

Answer 22

• disorder of sex development (DSD) is a condition in which an individual with one X chromosome and one Y chromosome in each cell, the pattern normally found in males, have genitalia that is not clearly male or female. Infants with this condition tend to have penoscrotal hypospadias, abnormal development of the testes, and reduced to no sperm production. - swyer syndrome

Question 23

what causes sperm to develop

Answer 23

testosterone

Question 24

What are the two types of declarative memory

Answer 24

• episodic - personal episode’s in time and space
• semantic - facts, meanings, concept and knowledge
• these require conscious recall

Question 25

What is a type of non-declarative memory

Answer 25

procedural - skills and habits | - this does not require conscious recall as you automatically know how do to it

Question 26

what is social capital

Answer 26

Social capital is defined by the OECD as “networks together with. shared norms, values and understandings that facilitate co-operation within or among groups

Question 27

what is the definition of gender via stonewall

Answer 27

Often expressed in terms of masculinity and femininity, gender is largely culturally determined and is assumed from the sex assigned at birth. gender identity - A person’s innate sense of their own gender, whether male, female or something else (see non-binary below), which may or may not correspond to the sex assigned at birth

Question 28

Phases of clinical trails

Answer 28

Phase 1 • To find a safe dose • To decide how (treatment schedule) the new treatment should be given • To see how the new treatment affects the human body • To look for a signal of efficacy in certain types of cancer Phase 2 • To assess the efficacy in a specific cancer type endpoints: response rates, duration of response, overall survival • To assess safety Phase 3 • To compare the new treatment (or new use of a treatment) with the current standard treatment Phase 4 - pharmacoviglience and long term side effects

Question 29

Name the weeks of bone healing

Answer 29

Fracture haematoma (6-8 hours) - blood clot forms via the broken blood vessels - 6-8 hours after the initial injury - hypoxia is caused due to a lack of blood vessels as they are broken this lowers the pH and allows pro inflammatory neutrophils, lymphocytes and macrophages to move in and to take away necrotic bone cells, blood vessels and any dead cells to make the site nice and clean - there is swelling and inflammation to dead bone cells at fracture site fibrocartilaginous callus (lasts about 3 weeks) lasts about 3 weeks - new capillaries organise fracture haematoma into granulation tissue - procallus - fibroblasts and osteogenic cells invade the procalllus - make collagen fibres which connect ends together - chondroblast begin to produce fibrocartilage - Fibroblasts enter and differentiate as chondrocytes - chondrocytes produce collagen that bridges fracture site cartilage and trabecular bone is laid down bony callus (after 3 weeks and lasts abut 3-4 months) - bony callus forms as the bone starts to be made - osteoblasts make the woven bone which replaces the fibrocartilage bone remodelling - Osteoclasts remodel woven bone into compact (lamellar) bone and trabecular bone - often there is no trace of fracture line on Xray